| NPI | 1497308845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT.002418) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0003513) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2020-07-22 |